Basic Information
| Provider Information | |||||||||
| NPI: | 1346227238 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTO | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 621 W MAIN ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | LIGONIER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156581017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242384103 | ||||||||
| FaxNumber: | 7242384107 | ||||||||
| Practice Location | |||||||||
| Address1: | 621 W MAIN ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | LIGONIER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156581017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242384103 | ||||||||
| FaxNumber: | 7242384107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2005 | ||||||||
| LastUpdateDate: | 10/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD050755L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001441304 | 05 | PA | MEDICAID |